Invited review
Brain damage in hypertension

Hypertension is the most important risk factor for stroke and may also predispose to the development of more subtle cerebral damage based on arteriolar narrowing or pathological microvascular changes. Age and high blood pressure are responsible for silent structural and functional cerebral changes leading to white matter lesions, lacunar infarction, and cognitive impairment. Some reports suggest that antihypertensive drug treatment and blood pressure control may play a role in preventing the progression of silent cerebrovascular damage, cognitive impairment and dementia. Prevention of stroke by antihypertensive therapy is well established, and recent trials indicate that blood pressure lowering is also beneficial in reducing stroke recurrence even among stroke patients with no history of hypertension. Early treatment of high blood pressure may prevent progression of silent structural and functional cerebral disease, with blood pressure reduction sustained to target values being the main priority for primary or secondary stroke prevention.